OBJECTIVE To evaluate the efficacy and safety of letermovir in preventing cytomegalovirus(CMV)infection after allogeneic hematopoietic stem cell transplantation(allo-HSCT).METHODS A retrospective cohort study was conducted,enrolling patients who underwent allo-HSCT at the Department of Hematology,Shanghai General Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,from August 30,2022,to February 21,2024.Patients who initiated letermovir prophylaxis within 28 days post-transplantation were assigned to the experimental group(99 cases),while those who did not initiate letermovir within this period were assigned to the control group(18 cases).The incidence and clinical characteristics of CMV infection(including the number of CMV infection cases,the number of cases progressing to CMV disease,recurrent CMV disease,onset time of CMV infection,and treatment duration),immune function recovery within 120 days post-transplantation,and the occurrence of transplantation-related complications(including CD4+and CD8+T-cell recovery,Epstein-Barr virus infection,acute graft-versus-host disease,human herpesvirus 6 infection,and posttransplant lymphoproliferative disorders)and adverse events were recorded.Univariate and multivariate Cox regression analyses were performed to identify factors influencing CMV infection.RESULTS A total of 117 patients were included,among whom 15 developed CMV infection,5 progressed to CMV disease,and 2 experienced recurrent CMV disease.The CMV infection rate in the experimental group was significantly lower than that in the control group(P＜0.001),and the onset time of CMV infection was significantly delayed(P=0.014).The proportion of patients with CD4+T-cell counts≥200 cells/μL in the experimental group was significantly lower than that in the control group(P=0.022).During the follow-up period,elevated creatinine levels were observed in 1 patient,and nausea and vomiting were observed in 2 patients.Multivariate Cox regression analysis revealed that the use of high-dose corticosteroids was a risk factor for CMV infection(HR=6.230,95%CI of 1.255-30.926,P=0.025),while initiating letermovir within 28 days post-transplantation was a protective factor(HR=0.125,95%CI of 0.045-0.348,P＜0.001).CONCLUSIONS Early initiation of letermovir after allo-HSCT significantly reduces the CMV infection rate and delays the onset of infection,with favorable short-term safety.

Objective:To investigate the correlation between Kimmelstiel-Wilson nodule (KW nodule) and clinical indexes in patients with diabetic kidney disease (DKD), and analyze the efficacy of the clinical indexes in evaluating KW nodule.Methods:The clinical data of 60 patients with DKD from January 2015 to February 2024 in Jining First People′s Hospital were retrospectively analyzed. Among them, 35 patients had KW nodule (KW nodule group), and 25 patients did have KW nodule (non-KW nodule group). The clinical indexes, including hematological (creatinine, uric acid, urea nitrogen, globulin, albumin, glycosylated hemoglobin and hemoglobin) and urine routine (24 h urinary protein quantification, urinary red blood cell count and urinary white blood cell count) were recorded; the estimated glomerular filtration rate (eGFR) was calculated. Spearman correlation was used to analyze the correlation between clinical indexes and KW nodule. Multivariate Logistic regression was used to analyze the independent risk factors for KW nodule in patients with DKD. Receiver operating characteristic (ROC) curve was used to analyze the efficacy of clinical indexes in evaluating KW nodule.Results:The creatinine, urea nitrogen, 24 h urinary protein quantification and urine red blood cell count in KW nodule group were significantly higher than those in non-KW nodule group: 114 (89, 156) μmol/L vs. 70 (59, 87) μmol/L, 9.00 (6.90, 11.43) mmol/L vs. 5.10 (4.52, 7.55) mmol/L, 4.56 (2.36, 7.23) g vs. 1.40 (1.11, 1.97) g and (19.24 ± 12.64)×10 6/L vs. (9.24 ± 8.67)×10 6/L, the eGFR, albumin and hemoglobin were significantly lower than those in non-KW nodule group: (60.82 ± 28.16) ml/(min·1.73 m 2) vs. (98.34 ± 30.16) ml/(min·1.73 m 2), (30.21 ± 6.64) g/L vs. (39.89 ± 6.49) g/L and (107.54 ± 17.28) g/L vs. (136.87 ± 22.90) g/L, and there were statistical differences ( P<0.01); there were no statistical differences in uric acid, globulin, glycosylated hemoglobin and urinary white blood cell count between the two groups ( P>0.05). Spearman correlation analysis result showed that creatinine, urea nitrogen, 24 h urinary protein quantification and urine red blood cell count were positively correlated with KW nodule ( r = 0.471, 0.559, 0.510 and 0.411; P<0.01); the eGFR, albumin and hemoglobin were negatively correlated with KW nodule ( r = - 0.607, - 0.590 and - 0.600; P<0.01). Multivariate Logistic regression analysis result showed that high 24 h urinary protein quantification and low albumin were independent risk factors for KW nodule in patients with DKD ( OR = 3.415 and 0.829, 95% CI 1.002 to 8.956 and 0.690 to 0.995, P<0.05). ROC curve analysis result showed that the areas under the curve of eGFR, hemoglobin, albumin, creatinine, 24 h urinary protein quantification and urine red blood cell count for KW nodule in patients with DKD were 0.852, 0.840, 0.848, 0.836, 0.881 and 0.768, respectively; the optimal cut-off values were 69.00 ml/(min·1.73 m 2), 110.00 g/L, 31.75 g/L, 96.10 μmol/L, 2.60 g and 15.52 × 10 6/L. Conclusions:There is a good correlation between KW nodule and the clinical features of DKD patients. Decreased renal function, anemia, proteinuria and hypoproteinemia have strong suggestive effects on KW nodule. Especially, proteinuria is more closely related.

Objective To evaluate the predictive value of serum microRNA-19a-3p(miR-19a-3p),microRNA-146a(miR-146a)and 25-hydroxyvitamin D3[25-(OH)D3]for the prognosis of children with respiratory syncytial virus(RSV)bronchiolitis.Methods A total of 202 children with RSV bronchiolitis were enrolled as disease group,followed up for one year after discharge,and divided into good prognosis group(n=55)and poor prognosis group(n=147).Additionally,180 healthy chil-dren matched by gender and age were selected as control group.Serum levels of miR-19a-3p,miR-146a and 25-(OH)D3 were measured in both the disease and control groups.The clinical data and the levels of serum miR-19a-3p,miR-146a and25-(OH)D3 of children in the poor prognosis group and the good prognosis group were compared.The correlations of serum miR-19a-3p,miR-146a and 25-(OH)D3 with the prognosis of children and their predictive value for poor prognosis of chil-dren were analyzed.Multivariate Logistic regression analysis was used to screen the related influen-cing factors of poor prognosis in children.Results The proportion of smoking among family mem-bers,the expression levels of serum miR-19a-3p and miR-146 in the poor prognosis group were sig-nificantly higher than those in the good prognosis group,and the level of 25-(OH)D3 was signifi-cantly lower than that in the good prognosis group(P＜0.05).The expression levels of serum miR-19a-3p and miR-146a were positively correlated with the poor prognosis of the children(r=0.408,0.332,P＜0.001),and the level of serum 25-(OH)D3 was negatively correlated with the poor prognosis of the children(r=-0.386,P＜0.001).The results of receiver operating characteristic(ROC)curve analysis showed that the area under the curve(AUC)of serum miR-19a-3p,miR-146a and 25-(OH)D3 for predicting poor prognosis in children was 0.726,0.817 and 0.834,re-spectively.The AUC of the combined prediction of the three was 0.938,which was higher than that of the single prediction(Z=5.515,3.879,3.860,P＜0.001),and the sensitivity and specificity were 83.64％and 90.48％,respectively.The miR-19a-3p,miR-146a,25-(OH)D3 and smoking among family members were all influencing factors for the poor prognosis of children with RSV bron-chiolitis(P＜0.05).Conclusion Serum miR-19a-3p,miR-146a and 25-(OH)D3 all have cer-tain predictive values for the prognosis of children with RSV bronchiolitis,and the combined predic-tive value of the three is higher.

Objective:To investigate the correlation between Kimmelstiel-Wilson nodule (KW nodule) and clinical indexes in patients with diabetic kidney disease (DKD), and analyze the efficacy of the clinical indexes in evaluating KW nodule.Methods:The clinical data of 60 patients with DKD from January 2015 to February 2024 in Jining First People′s Hospital were retrospectively analyzed. Among them, 35 patients had KW nodule (KW nodule group), and 25 patients did have KW nodule (non-KW nodule group). The clinical indexes, including hematological (creatinine, uric acid, urea nitrogen, globulin, albumin, glycosylated hemoglobin and hemoglobin) and urine routine (24 h urinary protein quantification, urinary red blood cell count and urinary white blood cell count) were recorded; the estimated glomerular filtration rate (eGFR) was calculated. Spearman correlation was used to analyze the correlation between clinical indexes and KW nodule. Multivariate Logistic regression was used to analyze the independent risk factors for KW nodule in patients with DKD. Receiver operating characteristic (ROC) curve was used to analyze the efficacy of clinical indexes in evaluating KW nodule.Results:The creatinine, urea nitrogen, 24 h urinary protein quantification and urine red blood cell count in KW nodule group were significantly higher than those in non-KW nodule group: 114 (89, 156) μmol/L vs. 70 (59, 87) μmol/L, 9.00 (6.90, 11.43) mmol/L vs. 5.10 (4.52, 7.55) mmol/L, 4.56 (2.36, 7.23) g vs. 1.40 (1.11, 1.97) g and (19.24 ± 12.64)×10 6/L vs. (9.24 ± 8.67)×10 6/L, the eGFR, albumin and hemoglobin were significantly lower than those in non-KW nodule group: (60.82 ± 28.16) ml/(min·1.73 m 2) vs. (98.34 ± 30.16) ml/(min·1.73 m 2), (30.21 ± 6.64) g/L vs. (39.89 ± 6.49) g/L and (107.54 ± 17.28) g/L vs. (136.87 ± 22.90) g/L, and there were statistical differences ( P<0.01); there were no statistical differences in uric acid, globulin, glycosylated hemoglobin and urinary white blood cell count between the two groups ( P>0.05). Spearman correlation analysis result showed that creatinine, urea nitrogen, 24 h urinary protein quantification and urine red blood cell count were positively correlated with KW nodule ( r = 0.471, 0.559, 0.510 and 0.411; P<0.01); the eGFR, albumin and hemoglobin were negatively correlated with KW nodule ( r = - 0.607, - 0.590 and - 0.600; P<0.01). Multivariate Logistic regression analysis result showed that high 24 h urinary protein quantification and low albumin were independent risk factors for KW nodule in patients with DKD ( OR = 3.415 and 0.829, 95% CI 1.002 to 8.956 and 0.690 to 0.995, P<0.05). ROC curve analysis result showed that the areas under the curve of eGFR, hemoglobin, albumin, creatinine, 24 h urinary protein quantification and urine red blood cell count for KW nodule in patients with DKD were 0.852, 0.840, 0.848, 0.836, 0.881 and 0.768, respectively; the optimal cut-off values were 69.00 ml/(min·1.73 m 2), 110.00 g/L, 31.75 g/L, 96.10 μmol/L, 2.60 g and 15.52 × 10 6/L. Conclusions:There is a good correlation between KW nodule and the clinical features of DKD patients. Decreased renal function, anemia, proteinuria and hypoproteinemia have strong suggestive effects on KW nodule. Especially, proteinuria is more closely related.

To report 7 Chinese children with characteristic hyperpigmented macules on the forehead and temples. Among the 7 cases, there were 2 males and 5 females, with the age at onset ranging from 9 to 24 months (12.43 ± 5.32 months), and the disease duration being 1 - 4 months (2.57 ± 1.27 months). Skin examination revealed that the children presented with varying numbers of irregular brown macules and patches scattered on their foreheads and temples, without obvious desquamation. Dermoscopic examination revealed multiple yellowish-brown patches with irregular borders, and linear vessels were observable in some skin lesions. A diagnosis of acquired facial hyperpigmented macules was made in these children. The children received no treatment. After 2 years of follow-up, hyperpigmented macules completely subsided in 2 cases and regressed to varying degrees in 4 cases, while 1 case exhibited no changes in the skin lesions. Considering the literature and the cases discussed in this article, it is hypothesized that acquired facial hyperpigmented macules in young children may represent an independent condition.

Disulfidptosis is a novel pattern of cell death caused by disulfide stress and inadequate NADPH. Nonalcoholic fatty liver disease （NAFLD） is a group of metabolic diseases with the main pathological feature of fatty infiltration， and it is closely associated with insulin resistance and genetic susceptibility. Currently， the latest studies have shown that disulfide stress caused by disulfidptosis can result in hepatocyte death， thereby accelerating the progression of NAFLD. This article summarizes and analyzes the latest studies on disulfidptosis in NAFLD， in order to explore the application of disulfidptosis in NAFLD and provide new ideas for the prevention and treatment of NAFLD.

Objective:To explore the value of serum inflammation-related indicators in predicting the effect of neoadjuvant chemotherapy and postoperative disease-free survival (DFS) of triple-negative breast cancer (TNBC) patients with axillary lymph node metastasis.Methods:A retrospective case series study was conducted. The data of 99 TNBC patients with axillary lymph node metastasis who underwent surgery after EC-T regimen (sequential docetaxel followed by epirubicin and cyclophosphamide) neoadjuvant chemotherapy at Suzhou Municipal Hospital and Xiangcheng People's Hospital from June 2016 to May 2022 were collected. All patients were required to collect peripheral blood samples within one week prior to puncture, and platelet, neutrophil and lymphocyte counts were analyzed using the blood analyzer. C-reactive protein level was analyzed using the fully automated biochemical analyzer, and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and immune inflammatory index (SII) were further calculated. Patients were divided into pathological complete remission (pCR) group and non-pCR group based on postoperative Miller Payne score, and the levels of various serum inflammation-related indicators before neoadjuvant chemotherapy were compared between the two groups; non-pCR patients were divided into high and low groups based on the median level of each indicator. Kaplan-Meier method was used to analyze the postoperative DFS status of each group. The impact of serum inflammatory-related indicators before neoadjuvant chemotherapy on postoperative DFS of patients was analyzed using Cox proportional hazards model for univariate and multivariate analyses.Results:The median age [ M ( Q1, Q3)] of 99 patients was 50 years old (39 years old, 64 years old); 47 cases were human epidermal growth factor receptor (HER2)-, 33 cases were HER2+, and 19 cases were HER2++ and fluorescence in situ hybridization-negative; there were 22 cases of pCR patients and 77 cases of non-pCR patients. Twenty-nine patients experienced recurrence or metastasis after surgery. The platelet count, PLR and SII of pCR group before neoadjuvant chemotherapy were lower than those of non-pCR group, and the differences were statistically significant (all P < 0.05). Among non-pCR patients, the DFS of high lymphocyte count before neoadjuvant chemotherapy group was better than that of low lymphocyte count group, while the DFS of high CRP, NLR, PLR, and SII groups was worse than that of low CRP, NLR, PLR, and SII groups, and the differences were statistically significant (all P < 0.05). Univariate analysis showed that lymphocyte count, NLR, PLR, CRP, and SII before neoadjuvant chemotherapy were all influencing factors for postoperative DFS in TNBC patients with axillary lymph node metastasis after neoadjuvant chemotherapy (all P < 0.05). Multivariate analysis showed that SII was an independent influencing factor for postoperative DFS in TNBC patients with axillary lymph node metastasis after neoadjuvant chemotherapy ( HR = 2.406, 95% CI: 1.147-5.617, P = 0.024). Conclusions:Serum inflammation-related indicators before neoadjuvant chemotherapy can serve as predictive factors for the efficacy of neoadjuvant chemotherapy and postoperative DFS in TNBC patients with axillary lymph node metastasis.

Objective:To explore the efficacy of ansa cervicalis anterior root-recurrent laryngeal nerve (RLN) anastomosis in the treatment of unilateral vocal fold paralysis (UVFP) and to analyze the effect of different pathogenic factors on efficacy.Methods:From January 2010 to January 2022, 428 patients (187 males and 241 females) at Changhai Hospital with UVFP who underwent ansa cervicalis anterior root-RLN anastomosis due to thyroid surgery, thoracic surgery, idiopathic vocal ford paralysis or high cranial base injury were analyzed. The course of nerve injury ranged from 6 to 24 months. Videostroboscopy, auditory perceptual evaluation parameters (GRBAS including Grade, Roughness, Breathiness, Asthenia, Strain), Voice Handicap Index (VHI-10), acoustic analysis including Jitter, Shimmer and noise to harmonic ratio (NHR), maximum phonation time (MPT) and laryngeal electromyography were used to evaluate the surgery efficacy, and the therapeutic difference of the above 4 different etiology patients receiving the operation was compared. Data processing was performed using SPSS 26.0 statistical software, and Wilcoxon signed rank test was used. Kruskal Wallis one-way ANOVA was used for those with equal variance.Results:At 12 months after operation, the affected vocal ford position, vocal ford edge, glottal closure, symmetry and regularity of vocal ford vibration were significantly improved in all four groups ( P<0.01). G, R, B, A, S, VHI-10, Jitter, Shimmer and NHR were significantly lower than those before operation, while, MPT was significantly longer ( P<0.01). Also, the maximum voluntary motor unit recruitment (VMUR) in the affected thyroarytenoid muscles and posterior cricoarytenoid muscles was significantly improved after surgery ( P<0.01). However, the results of thyroid surgery group, thoracic surgery group and idiopathic vocal ford paralysis group were better than those of high cranial base injury group respectively, and the differences were statistically significant ( P<0.05). Conclusion:Ansa cervicalis anterior root-RLN anastomosis has an obvious efficacy on the recovery of phonatory function in UVFP patients with different causes, but the high cranial base injury is significantly worse than that of vocal ford paralysis caused by other causes.

Objective:To explore the value of serum inflammation-related indicators in predicting the effect of neoadjuvant chemotherapy and postoperative disease-free survival (DFS) of triple-negative breast cancer (TNBC) patients with axillary lymph node metastasis.Methods:A retrospective case series study was conducted. The data of 99 TNBC patients with axillary lymph node metastasis who underwent surgery after EC-T regimen (sequential docetaxel followed by epirubicin and cyclophosphamide) neoadjuvant chemotherapy at Suzhou Municipal Hospital and Xiangcheng People's Hospital from June 2016 to May 2022 were collected. All patients were required to collect peripheral blood samples within one week prior to puncture, and platelet, neutrophil and lymphocyte counts were analyzed using the blood analyzer. C-reactive protein level was analyzed using the fully automated biochemical analyzer, and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and immune inflammatory index (SII) were further calculated. Patients were divided into pathological complete remission (pCR) group and non-pCR group based on postoperative Miller Payne score, and the levels of various serum inflammation-related indicators before neoadjuvant chemotherapy were compared between the two groups; non-pCR patients were divided into high and low groups based on the median level of each indicator. Kaplan-Meier method was used to analyze the postoperative DFS status of each group. The impact of serum inflammatory-related indicators before neoadjuvant chemotherapy on postoperative DFS of patients was analyzed using Cox proportional hazards model for univariate and multivariate analyses.Results:The median age [ M ( Q1, Q3)] of 99 patients was 50 years old (39 years old, 64 years old); 47 cases were human epidermal growth factor receptor (HER2)-, 33 cases were HER2+, and 19 cases were HER2++ and fluorescence in situ hybridization-negative; there were 22 cases of pCR patients and 77 cases of non-pCR patients. Twenty-nine patients experienced recurrence or metastasis after surgery. The platelet count, PLR and SII of pCR group before neoadjuvant chemotherapy were lower than those of non-pCR group, and the differences were statistically significant (all P < 0.05). Among non-pCR patients, the DFS of high lymphocyte count before neoadjuvant chemotherapy group was better than that of low lymphocyte count group, while the DFS of high CRP, NLR, PLR, and SII groups was worse than that of low CRP, NLR, PLR, and SII groups, and the differences were statistically significant (all P < 0.05). Univariate analysis showed that lymphocyte count, NLR, PLR, CRP, and SII before neoadjuvant chemotherapy were all influencing factors for postoperative DFS in TNBC patients with axillary lymph node metastasis after neoadjuvant chemotherapy (all P < 0.05). Multivariate analysis showed that SII was an independent influencing factor for postoperative DFS in TNBC patients with axillary lymph node metastasis after neoadjuvant chemotherapy ( HR = 2.406, 95% CI: 1.147-5.617, P = 0.024). Conclusions:Serum inflammation-related indicators before neoadjuvant chemotherapy can serve as predictive factors for the efficacy of neoadjuvant chemotherapy and postoperative DFS in TNBC patients with axillary lymph node metastasis.

Objective:To explore the efficacy of ansa cervicalis anterior root-recurrent laryngeal nerve (RLN) anastomosis in the treatment of unilateral vocal fold paralysis (UVFP) and to analyze the effect of different pathogenic factors on efficacy.Methods:From January 2010 to January 2022, 428 patients (187 males and 241 females) at Changhai Hospital with UVFP who underwent ansa cervicalis anterior root-RLN anastomosis due to thyroid surgery, thoracic surgery, idiopathic vocal ford paralysis or high cranial base injury were analyzed. The course of nerve injury ranged from 6 to 24 months. Videostroboscopy, auditory perceptual evaluation parameters (GRBAS including Grade, Roughness, Breathiness, Asthenia, Strain), Voice Handicap Index (VHI-10), acoustic analysis including Jitter, Shimmer and noise to harmonic ratio (NHR), maximum phonation time (MPT) and laryngeal electromyography were used to evaluate the surgery efficacy, and the therapeutic difference of the above 4 different etiology patients receiving the operation was compared. Data processing was performed using SPSS 26.0 statistical software, and Wilcoxon signed rank test was used. Kruskal Wallis one-way ANOVA was used for those with equal variance.Results:At 12 months after operation, the affected vocal ford position, vocal ford edge, glottal closure, symmetry and regularity of vocal ford vibration were significantly improved in all four groups ( P<0.01). G, R, B, A, S, VHI-10, Jitter, Shimmer and NHR were significantly lower than those before operation, while, MPT was significantly longer ( P<0.01). Also, the maximum voluntary motor unit recruitment (VMUR) in the affected thyroarytenoid muscles and posterior cricoarytenoid muscles was significantly improved after surgery ( P<0.01). However, the results of thyroid surgery group, thoracic surgery group and idiopathic vocal ford paralysis group were better than those of high cranial base injury group respectively, and the differences were statistically significant ( P<0.05). Conclusion:Ansa cervicalis anterior root-RLN anastomosis has an obvious efficacy on the recovery of phonatory function in UVFP patients with different causes, but the high cranial base injury is significantly worse than that of vocal ford paralysis caused by other causes.